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Montana rates for HCPCS L1100

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $123.03 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $151.36 / $186.21
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $173.78 / $338.84
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $173.78 / $338.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $165.96 / $245.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $141.25 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $102.33 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $102.33